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Record of Grantee Meetings
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Resources

Multiple Self Management Behaviors

Summary

Participant Registration Form (PDF)

This one-page assessment tool is designed to be used by self management program staff to gather baseline information about patients or program participants. It includes questions about demographics, disease history and lifestyle behaviors such as exercise and smoking.

Author site: Gateway Community Health Center I 2003

Related Links

  • For more assessment tools: Click here
  • For other tools related to general program administration: Click here
  • For other tools on multiple self management behaviors: Go back

The Diabetes Initiative was a national program of the Robert Wood Johnson Foundation from 2002 to 2009.
Archived in 2009, this site is a repository for information and resources gathered over the course of the Initiative.
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